The Affordable Care Act: Healthcare Reform 101. Gail R. Wilensky Project HOPE April 4, 2014

Transcription

1 The Affordable Care Act: Healthcare Reform 101 Gail R. Wilensky Project HOPE April 4,

2 Wide Agreement on the Challenges Long-term spending growth Problems with patient safety Problems with quality/clinical appropriateness and Too Many Uninsured! 2

3 Unclear What's Happening With Spending Healthcare spending has been growing at historically low rates % in expect 4% in 2013 Unclear how much is recession-related v. ACA-related Economy is picking up and so is health care spending -- 4 th quarter 2013, health care spending 5.6%; fastest pace in 10 years Too soon to know! 3

4 Focus of the ACA Thus Far Initial expansions of coverage; getting ready for 2014 Insurance reforms Limited delivery system reforms -- value based purchasing, Accountable Care Org. Medicare Innovation Center and its pilot projects -- bundling pilots, medical homes, primary care 4

5 Most Agree --- Incentives in Health Care Need to be Reformed Most of Medicare uses bundled payments -- encourages efficiency within the bundle but no reward for quality, outcome or overall cost Care coordination is key especially for seniors with chronic conditions -- little reimbursement under FFS except for PCMH; MA plans are better suited 5

6 Desperately Needed: Physician Payment Reform Too much attention on the SGR spending limit -- not enough on changing reimbursement Difficult to reform health care without reforming how physicians are paid SGR repeal bill stalled; temp patch is back -- better rewards for value and efficiency -- challenges of financing $140 billion cost 6

7 Interesting Medicare Demos Past: Present: Future Premier demo; physician group practice demo Gain sharing demo; medical homes Bundling demos of hospitals with post-acute; physicians with hospitals; hospitals with all services; discounted DRG Missing Demo: How to reimburse physicians separately from hospitals 7

8 Challenge: Translating Pilots Into Practice Historical precedence: Discouraging! -- even successful demos rarely become law But Secretary has new authority under ACA -- can scale-up successful pilots -- can make successful pilots national Still can will 8

9 Also Need Liability Reform to Drive Change Need to protect docs/institutions who practice conservative medicine Arbitrary caps on pain/suffering don t improve quality Need to consider quid pro quo strategy -- get protection if adopt IOM patient-safety measures, evidenced-based clinical protocols -- no provable criminal negligence 9

10 Initial Expectations Have Been Tempered Administration: (2010) 32 million fewer uninsured million on Medicaid million subsidized in Exchanges Latest CBO: ( ) 25 million fewer uninsured Medicaid/CHIP million in Exchanges (12 million fewer thru employers and non-group) 31 million will remain uninsured in 2023! 10

11 Obamacare s Effect on the Uninsured: What CBO Predicts These are obviously just projections 11

12 Most Polls Continue to Show Negative ACA Views CBS News: 53% negative v. 41% positive KFF Poll: AP/GFK: 46% negative v. 38% positive Only 26% positive BUT 3/31 ABC/WP polls shows 49% support v. 48% against Most people don t want or don t think ACA will be repealed 12

13 Many Unknowns Ahead Will 2014 continue to be bumpy? Will more reluctant Republican governors change their position on Medicaid? After November? How many young/healthy people will enroll? How many enrollees will pay? All year? How will employers respond? In 2016? 13

14 With Expected Challenges In the Near-Term in credibility in Federal gov t capability with exchange snafu s Expect large in demand for care (starting 2014) -- especially concentrated in South and SE -- raises workforce questions Continued financial pressure from reductions in Medicare reimbursement 14

15 What Happens Next? What happens when newly insured try to use health care? What happens if they stop paying their premiums? Will the bumpy roll-out affect the 2014 election? -- Will the 2014 election affect the ACA? When will clean-up legislation start? Take Note: ACA is only Health Care Reform 1.0; More legislation will be coming... 15